title: The association of comorbid depression with intensive care unit admission in patients with diabetes: a prospective cohort study.
abstract: BACKGROUND
  It is unknown if comorbid depression in patients with diabetes mellitus increases the risk of intensive care unit (ICU) admission.
  
  
  OBJECTIVE
  This study examined whether comorbid depression in patients with diabetes increased risk of ICU admission, coronary care unit (CCU) admission, and general medical-surgical unit hospitalization, as well as total days hospitalized, after controlling for demographics, clinical characteristics, and health risk behaviors.
  
  
  METHODS
  This prospective cohort study included 3,596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study. We assessed baseline depression with the Patient Health Questionnaire-9. We controlled for baseline demographics, smoking, BMI, exercise, hemoglobin A(1c), medical comorbidities, diabetes complications, type 1 diabetes, diabetes duration, and insulin treatment. We assessed time to any ICU, CCU, and/or general medical-surgical unit admission using Cox proportional-hazards regression. We used Poisson regression with robust standard errors to examine associations between depression and total days hospitalized.
  
  
  RESULTS
  Unadjusted analyses revealed that baseline probable major depression was associated with increased risk of ICU admission [hazard ratio (HR) 1.94, 95% confidence interval (95% CI)(1.34-2.81)], but was not associated with CCU or general medical-surgical unit admission. Fully adjusted analyses revealed probable major depression remained associated with increased risk of ICU admission [HR 2.23, 95% CI(1.45-3.45)]. Probable major depression was also associated with more total days hospitalized (Incremental Relative Risk 1.64, 95%CI(1.26-2.12)).
  
  
  CONCLUSIONS
  Patients with diabetes and comorbid depression have a greater risk of ICU admission. Improving depression treatment in patients with diabetes could potentially prevent hospitalizations for critical illnesses and lower healthcare costs.
authors.affiliation: Dept. of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Seattle, WA 98195, USA. ddavydo1@u.washington.edu
authors.forename: Dimitry S
authors.initials: DS
authors.lastname: Davydow
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology